<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket="http://wicket.apache.org">
<wicket:panel>
    <h2>Tijdelijk adres</h2>
    <div wicket:id="container" class="form-horizontal">
        <div class="control-group">
            <label class="control-label">Straatnaam</label>
            <div class="controls">
                <input wicket:id="straat" class="input-large" type="text" value="">
            </div>
        </div>
        <div class="row-fluid">
            <div class="span6">
                <div class="control-group">
                    <label class="control-label">Huisnummer</label>
                    <div class="controls">
                        <input wicket:id="huisnummer" class="input-small" type="text" value="">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label">Huisletter</label>
                    <div class="controls">
                        <input wicket:id="huisletter" class="input-small" type="text" value="">
                    </div>
                </div>
            </div>
            <div class="span6">
                <div class="control-group">
                    <label class="control-label">Huisnummertoevoeging</label>
                    <div class="controls">
                        <input wicket:id="huisnummerToevoeging" class="input-small" type="text" value="">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label">Aanduiding bij huisnummer</label>
                    <div class="controls">
                        <input wicket:id="huisnummerAanduiding" class="input-small" type="text" value="">
                    </div>
                </div>
            </div>
        </div>
        <div class="control-group">
            <label class="control-label">Postcode</label>
            <div class="controls">
                <input wicket:id="postcode" class="input-mini" type="text" value="">
            </div>
        </div>
        <div class="control-group">
            <label class="control-label">Plaats</label>
            <div class="controls">
                <input wicket:id="plaats" class="input-large" type="text" value="">
            </div>
        </div>
        <div class="control-group">
            <label class="control-label">Periode</label>
            <div class="controls">
                <div class="input-append">
                    <input wicket:id="startDatum" class="datum vanaf" type="text" value="">
                    <a href="javascript:void(0);" class="btn" onclick="$(this).parent().find('.vanaf').datepicker('show');return false;" title="Datum" tabindex="-1"><i
                            class="icon-calendar"></i></a>
                </div>
                t/m
                <div class="input-append">
                    <input wicket:id="eindDatum" class="datum tot" type="text" value="">
                    <a href="javascript:void(0);" class="btn" onclick="$(this).parent().find('.tot').datepicker('show');return false;" title="Datum" tabindex="-1"><i
                            class="icon-calendar"></i></a>
                </div>
            </div>
        </div>
    </div>
</wicket:panel>
</html>
